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Papers by Johannes Zacherl
European Surgery, 2015
Background Esophagectomy for primary esophageal cancer is a high-risk procedure. The main reason ... more Background Esophagectomy for primary esophageal cancer is a high-risk procedure. The main reason for hospital mortality is respiratory morbidity. A fast recovery protocol has been introduced to enhance recovery and to reduce postoperative morbidity. Methods Patients who underwent minimally invasive, hybrid, or open abdominothoracic esophagectomy and intrathoracic esophagogastrostomy between June 2006 and October 2009 were perioperatively managed according to a multistep recovery protocol. Patients with colon interposition, jejunum interposition, Roux-en-Y reconstruction, or chest or supradiaphragmatic anastomosis were excluded from the respective fast-track protocol. Association between several circumstances and protocol dropout was evaluated. Results Overall, 90 consecutive patients (median age, 64.3 years; 17 female) were intended to be treated according to the fast recovery protocol. Major morbidity was 21.1 %, respiratory morbidity was 11.1 %, and hospital mortality was 3.3 %. Protocol failure occurred in 36.7 %, and readmission rate was 2.2 %. Factors associated with failure were pre-existing combined comorbidities (i.e., ASA 3), blood transfusions, thoracoscopic creation of the esophagogastrostomy, and postoperative major complications. Conclusions The fast-track goal was reached in almost two-thirds of patients undergoing Ivor Lewis resection. Multimodal measures reduce pulmonary complication and pneumonia rate without increasing surgical morbidity.
Surgery, 2013
Tumor-associated lymphatic networks are the primary routes for tumor cell dissemination and metas... more Tumor-associated lymphatic networks are the primary routes for tumor cell dissemination and metastasis. Behind the background of possible lymphangiogenesis-associated therapies, the clinical impact of lymphangiogenesis (measured by lymphatic microvessel density [LMVD]) and specific lymphovascular invasion (LVI) in esophageal cancer remains unclear. The aim of this study was to evaluate the clinical role of lymphangiogenesis and LVI in a large cohort of esophageal cancer. For the specific assessment of LMVD and LVI, 393 tissue samples from a prospective tissue databank of esophageal adenocarcinomas, squamous cell carcinomas, and their precursor lesions were included into this study. LMVD and LVI were assessed by immunostaining for podoplanin, a selective marker of lymphatic endothelium. In addition the peritumoral inflammatory stroma reaction (ISR) was assessed. Patients with high LMVD had a significant increased risk to develop LVI (P = .00123; coefficient of regression [CR] 0.27) a...
Anticancer research
A retrospective analysis was carried out on the efficacy and toxicity of the combination of 5-flu... more A retrospective analysis was carried out on the efficacy and toxicity of the combination of 5-fluorouracil, leucovorin, etoposide and cisplatin (FLEP) in patients with metastatic esophageal cancer treated at our institution. Patients received intravenous 5-fluorouracil 500 mg/m2, leucovorin 300 mg/m2, etoposide 100 mg/m2 and cisplatin 30 mg/m2, on days 1 to 3. Courses were repeated every 4 weeks until progression or up to a maximum of 6 courses. Patients were evaluated for response after every three courses using computed tomography. Eighteen patients received a total of 76 courses (median 4, range 1-6). The median time to progression was 9.2 months and the overall response rate was 22% (one complete response i.e. 5%, and three partial responses i.e. 17%). Seven patients (39%) had stable disease, while another 7 progressed during therapy. The median survival for all patients was 10.2 months. The most common hematological toxicities were leukocytopenia and neutropenia grade 3, which ...
Surgical Endoscopy, 2004
Background: Laparoscopic donor nephrectomy (LDN) increases incentives to donation by subjects who... more Background: Laparoscopic donor nephrectomy (LDN) increases incentives to donation by subjects who might refuse an open operation. However, the incidence of delayed graft function is higher after LDN than after open operation. This may be caused by the reduction of renal perfusion as a result of the raised intraabdominal pressure and mechanically induced renal angiospasm during the operation. We conducted experiments to find out whether the application of papaverine around the renal artery during LDN could improve early graft function after transplantation. Methods: Renal function was studied in 10 male pigs (weight 25 kg). The left kidney was harvested laparoscopically (intraabdominal pressure 8 mmHg). Five animals were randomly selected to have perivascular application of 50 mg papaverine (treatment group) before preparation of the vessels. In controls no papaverine was used. After LDN and open right nephrectomy the left kidney was autotransplanted. The main outcome measures were volume of urine produced and creatinine clearance during the first 20 h after the transplant. Results: The groups were comparable in respect of body weight, hemodynamic values, amount of infusions, warm and cold ischemia time, and duration of anastomosis. Urine output and creatinine clearance were significantly higher in pigs treated with papaverine than in controls. Conclusions: Papaverine substantially improved early graft function in pigs when applied around the renal artery during LDN. Whether this is applicable to procurement of human kidneys remains to be evaluated.
Gastroenterology, 2012
respectively and TRG 2 and 3 as minimal and poor response respectively)by single experienced path... more respectively and TRG 2 and 3 as minimal and poor response respectively)by single experienced pathologist blinded to clinical data. Post NACRT PET-CT Standard uptake value (SUVmax) and percentage change of SUVmax was correlated with tumor regression (TRG 0 and 1). Results-Transhiatal esophagectomy was done in 30 patients and Transthoracic esophagectomy in 2 patients. Two patients had metastatic disease at surgery. Mean SUVmax was 13.6 and 6.45 for Pre NACRT and Post NACRT respectively suggesting metabolic response to therapy. Tumor regression (TRG 0 and 1) was seen in 12 (35.3%) patients. The percentage decrease in SUVmax >80% correlated with tumor regression with sensitivity, specificity, PPV, NPV and accuracy of 71.4%, 92.8%, 83.3%, 80% and 85.7% respectively. Post NACRT SUVmax <4.0 correlated with tumor regression with sensitivity, specificity, PPV, NPV and accuracy of 83.3%, 86.3%, 76.9%, 90.4% and 85% respectively Conclusions-18F FDG PET/CT is 85% accurate in response assessment of Neoadjuvant Chemoradiation for squamous cell carcinoma esophagus. PET-CT images with complete metabolic response in a 72 year old male Gross and Microscopic tumor regression (Complete pathological response) CAP TRG 0 in the same patient.
Journal of Gastrointestinal Oncology, 2020
Background: Ramucirumab is a VEGFR-2 antibody that has proven to prolong overall survival (OS) in... more Background: Ramucirumab is a VEGFR-2 antibody that has proven to prolong overall survival (OS) in patients with pretreated metastatic gastric/gastrooesophageal junction (GEJ) adenocarcinoma. We present data from patients treated with ramucirumab and paclitaxel or FOLFIRI after failure of at least one platinum-and 5-FU-containing chemotherapy (CHT) regimen. Methods: In this retrospective two-center study, 56 patients with metastatic gastric cancer (47%) or adenocarcinoma of the GEJ (53%) were treated with paclitaxel and ramucirumab (n=38) as second-line (75%) or beyond second-line (25%) therapy. FOLFIRI-ramucirumab (FOLFIRI-R) (n=16) was given to patients with a short interval between taxane-based perioperative CHT and occurrence of metastatic disease or to those ineligible for paclitaxel. Results: The median progression-free survival (PFS) and OS for patients treated with paclitaxelramucirumab (pacl-R) were 2.9 (95% CI: 2.3-3.6) and 4.4 (4.1-4.7) months, respectively, and those for patients treated with FOLFIRI-R were 5.9 (95% CI: 0.35-11.4) and 8.3 (6.6-10) months, respectively (P=0.05). We observed a trend towards prolonged PFS after perioperative taxane-based FLOT CHT (n=12) with FOLFIRI-R compared with pacl-R. Adverse events were manageable, with neutropenia and polyneuropathy (PNP) being the most common events. More than two treatment lines were given to 48.2% of patients. Conclusions: The use of ramucirumab in combination with FOLFIRI showed favourable PFS and OS in patients with prior treatments with platinum and/or taxane-based agents and allows further treatment lines after progression. In patients with taxane pretreatment or persistent high-grade PNP, the combination of FOLFIRI-R might be a promising combination.
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress, 1997
A total of 630 endoscopic thoracal sympathicotomies were performed for hyperhidrosis of the upper... more A total of 630 endoscopic thoracal sympathicotomies were performed for hyperhidrosis of the upper limbs, and complications and success rates were analyzed after a median follow-up period of 16 years (83% of patients). In all, 67.8% of patients were fully satisfied, 25.7% were partially satisfied and would again agree to the operation, and 93% the procedure terminated hyperhidrosis permanently. Compensatory and gustatory sweating was observed in 67% und 47% of cases, respectively, impairing the patients satisfaction. Overall success was significantly (p < 0.001) lower in the group with axillary hyperhidrosis.
The American Journal of Surgical Pathology, 2010
The human epidermal growth factor receptor-2 gene (HER-2) encodes for a membrane-bound tyrosine k... more The human epidermal growth factor receptor-2 gene (HER-2) encodes for a membrane-bound tyrosine kinase (Her-2), which is overexpressed in various human cancers. Her-2-targeted therapy has recently been shown to be beneficial for patients with advanced gastric cancer. Her-2 protein expression was investigated in 341 esophageal carcinomas [152 squamous cell carcinomas (SCC), 189 adenocarcinomas (AC)], 39 cases of Barrett mucosa, and 11 cases of squamous cell dysplasia. HER-2 gene amplification was assessed by colorimetric in-situ hybridization. Positive Her-2 status was found in 15.3% of ACs and 3.9% of SCCs. Positive Her-2-status was more common in dysplastic Barrett mucosas compared with nondysplastic ones (P=0.04). In 26% of the patients with ACs who had received neoadjuvant chemotherapy (n=39), the Her-2 status of pretherapeutic biopsies was different compared with subsequent surgical specimens. There was no statistically significant correlation between Her-2 status and patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; survival. Although Her-2 overexpression is rare in SCCs, it is found in 15.3% of ACs, where amplification of HER-2 gene and overexpression of Her-2 protein seem to be early events in carcinogenesis. The evaluation of Her-2 status in tumor biopsies and in particular in the context with possible alterations after neoadjuvant treatment can potentially lead to false Her-2-staging. Although Her-2-overexpression in esophageal cancer seems to have no influence on patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; survival, these subtypes of esophageal ACs have to be considered as targets for an anti-Her-2 therapy.
Diseases of the Colon & Rectum, 1999
Surgical Endoscopy, 2014
Background Both long-term proton pump inhibitor (PPI) use and surgical fundoplication have potent... more Background Both long-term proton pump inhibitor (PPI) use and surgical fundoplication have potential drawbacks as treatments for chronic gastroesophageal reflux disease (GERD). This multi-center, prospective study evaluated the clinical experiences of 69 patients who received an alternative treatment: endoscopic anterior fundoplication with a video-and ultrasound-guided transoral surgical stapler. Methods Patients with well-categorized GERD were enrolled at six international sites. Efficacy data was compared at baseline and at 6 months post-procedure. The primary endpoint was a C50 % improvement in GERD health-related quality of life (HRQL) score. Secondary endpoints were elimination or C50 % reduction in dose of PPI medication and reduction of total acid exposure on esophageal pH probe monitoring. A safety evaluation was performed at time 0 and weeks 1, 4, 12, and 6 months.
Journal für Gastroenterologische und Hepatologische Erkrankungen
European Journal of Plastic Surgery
The study was performed to evaluate abdominal complications related to jejunal segment resection ... more The study was performed to evaluate abdominal complications related to jejunal segment resection for reconstruction after radical oropharyngeal tumor resection. Perioperative complications of 104 patients (median age, 53.7 years; 23 female; 81 male) who underwent surgery for oropharyngeal malignancy after radiochemotherapy and the long-term morbidity of 35 patients after a median follow-up period of 21 months are analyzed. The perioperative mortality was 8.7% (9/104); none of the perioperative deaths was caused by an abdominal complication associated with the jejunal resection. In three cases, repeat laparotomy was performed within 30 days of jejunal autotransplantation: in two of them the reason was not directly associated with bowel resection and one patient had an abdominal wall dehiscence. In six cases there were minor abdominal complications which could be treated nonsurgically. There was no anastomotic leakage, bowel obstruction or postoperative bleeding. In the follow-up re-examination, no late onset abdominal complications were noted except small incisional hernias in six of the 35 patients; only one required a hernia repair. Despite a potentially increased operative risk in these patients, the complication rate after bowel resection for jejunal autotransplantation was low. This is a safe procedure in patients with oropharyngeal carcinoma.
European Surgery, 2015
Background Esophagectomy for primary esophageal cancer is a high-risk procedure. The main reason ... more Background Esophagectomy for primary esophageal cancer is a high-risk procedure. The main reason for hospital mortality is respiratory morbidity. A fast recovery protocol has been introduced to enhance recovery and to reduce postoperative morbidity. Methods Patients who underwent minimally invasive, hybrid, or open abdominothoracic esophagectomy and intrathoracic esophagogastrostomy between June 2006 and October 2009 were perioperatively managed according to a multistep recovery protocol. Patients with colon interposition, jejunum interposition, Roux-en-Y reconstruction, or chest or supradiaphragmatic anastomosis were excluded from the respective fast-track protocol. Association between several circumstances and protocol dropout was evaluated. Results Overall, 90 consecutive patients (median age, 64.3 years; 17 female) were intended to be treated according to the fast recovery protocol. Major morbidity was 21.1 %, respiratory morbidity was 11.1 %, and hospital mortality was 3.3 %. Protocol failure occurred in 36.7 %, and readmission rate was 2.2 %. Factors associated with failure were pre-existing combined comorbidities (i.e., ASA 3), blood transfusions, thoracoscopic creation of the esophagogastrostomy, and postoperative major complications. Conclusions The fast-track goal was reached in almost two-thirds of patients undergoing Ivor Lewis resection. Multimodal measures reduce pulmonary complication and pneumonia rate without increasing surgical morbidity.
Surgery, 2013
Tumor-associated lymphatic networks are the primary routes for tumor cell dissemination and metas... more Tumor-associated lymphatic networks are the primary routes for tumor cell dissemination and metastasis. Behind the background of possible lymphangiogenesis-associated therapies, the clinical impact of lymphangiogenesis (measured by lymphatic microvessel density [LMVD]) and specific lymphovascular invasion (LVI) in esophageal cancer remains unclear. The aim of this study was to evaluate the clinical role of lymphangiogenesis and LVI in a large cohort of esophageal cancer. For the specific assessment of LMVD and LVI, 393 tissue samples from a prospective tissue databank of esophageal adenocarcinomas, squamous cell carcinomas, and their precursor lesions were included into this study. LMVD and LVI were assessed by immunostaining for podoplanin, a selective marker of lymphatic endothelium. In addition the peritumoral inflammatory stroma reaction (ISR) was assessed. Patients with high LMVD had a significant increased risk to develop LVI (P = .00123; coefficient of regression [CR] 0.27) a...
Anticancer research
A retrospective analysis was carried out on the efficacy and toxicity of the combination of 5-flu... more A retrospective analysis was carried out on the efficacy and toxicity of the combination of 5-fluorouracil, leucovorin, etoposide and cisplatin (FLEP) in patients with metastatic esophageal cancer treated at our institution. Patients received intravenous 5-fluorouracil 500 mg/m2, leucovorin 300 mg/m2, etoposide 100 mg/m2 and cisplatin 30 mg/m2, on days 1 to 3. Courses were repeated every 4 weeks until progression or up to a maximum of 6 courses. Patients were evaluated for response after every three courses using computed tomography. Eighteen patients received a total of 76 courses (median 4, range 1-6). The median time to progression was 9.2 months and the overall response rate was 22% (one complete response i.e. 5%, and three partial responses i.e. 17%). Seven patients (39%) had stable disease, while another 7 progressed during therapy. The median survival for all patients was 10.2 months. The most common hematological toxicities were leukocytopenia and neutropenia grade 3, which ...
Surgical Endoscopy, 2004
Background: Laparoscopic donor nephrectomy (LDN) increases incentives to donation by subjects who... more Background: Laparoscopic donor nephrectomy (LDN) increases incentives to donation by subjects who might refuse an open operation. However, the incidence of delayed graft function is higher after LDN than after open operation. This may be caused by the reduction of renal perfusion as a result of the raised intraabdominal pressure and mechanically induced renal angiospasm during the operation. We conducted experiments to find out whether the application of papaverine around the renal artery during LDN could improve early graft function after transplantation. Methods: Renal function was studied in 10 male pigs (weight 25 kg). The left kidney was harvested laparoscopically (intraabdominal pressure 8 mmHg). Five animals were randomly selected to have perivascular application of 50 mg papaverine (treatment group) before preparation of the vessels. In controls no papaverine was used. After LDN and open right nephrectomy the left kidney was autotransplanted. The main outcome measures were volume of urine produced and creatinine clearance during the first 20 h after the transplant. Results: The groups were comparable in respect of body weight, hemodynamic values, amount of infusions, warm and cold ischemia time, and duration of anastomosis. Urine output and creatinine clearance were significantly higher in pigs treated with papaverine than in controls. Conclusions: Papaverine substantially improved early graft function in pigs when applied around the renal artery during LDN. Whether this is applicable to procurement of human kidneys remains to be evaluated.
Gastroenterology, 2012
respectively and TRG 2 and 3 as minimal and poor response respectively)by single experienced path... more respectively and TRG 2 and 3 as minimal and poor response respectively)by single experienced pathologist blinded to clinical data. Post NACRT PET-CT Standard uptake value (SUVmax) and percentage change of SUVmax was correlated with tumor regression (TRG 0 and 1). Results-Transhiatal esophagectomy was done in 30 patients and Transthoracic esophagectomy in 2 patients. Two patients had metastatic disease at surgery. Mean SUVmax was 13.6 and 6.45 for Pre NACRT and Post NACRT respectively suggesting metabolic response to therapy. Tumor regression (TRG 0 and 1) was seen in 12 (35.3%) patients. The percentage decrease in SUVmax >80% correlated with tumor regression with sensitivity, specificity, PPV, NPV and accuracy of 71.4%, 92.8%, 83.3%, 80% and 85.7% respectively. Post NACRT SUVmax <4.0 correlated with tumor regression with sensitivity, specificity, PPV, NPV and accuracy of 83.3%, 86.3%, 76.9%, 90.4% and 85% respectively Conclusions-18F FDG PET/CT is 85% accurate in response assessment of Neoadjuvant Chemoradiation for squamous cell carcinoma esophagus. PET-CT images with complete metabolic response in a 72 year old male Gross and Microscopic tumor regression (Complete pathological response) CAP TRG 0 in the same patient.
Journal of Gastrointestinal Oncology, 2020
Background: Ramucirumab is a VEGFR-2 antibody that has proven to prolong overall survival (OS) in... more Background: Ramucirumab is a VEGFR-2 antibody that has proven to prolong overall survival (OS) in patients with pretreated metastatic gastric/gastrooesophageal junction (GEJ) adenocarcinoma. We present data from patients treated with ramucirumab and paclitaxel or FOLFIRI after failure of at least one platinum-and 5-FU-containing chemotherapy (CHT) regimen. Methods: In this retrospective two-center study, 56 patients with metastatic gastric cancer (47%) or adenocarcinoma of the GEJ (53%) were treated with paclitaxel and ramucirumab (n=38) as second-line (75%) or beyond second-line (25%) therapy. FOLFIRI-ramucirumab (FOLFIRI-R) (n=16) was given to patients with a short interval between taxane-based perioperative CHT and occurrence of metastatic disease or to those ineligible for paclitaxel. Results: The median progression-free survival (PFS) and OS for patients treated with paclitaxelramucirumab (pacl-R) were 2.9 (95% CI: 2.3-3.6) and 4.4 (4.1-4.7) months, respectively, and those for patients treated with FOLFIRI-R were 5.9 (95% CI: 0.35-11.4) and 8.3 (6.6-10) months, respectively (P=0.05). We observed a trend towards prolonged PFS after perioperative taxane-based FLOT CHT (n=12) with FOLFIRI-R compared with pacl-R. Adverse events were manageable, with neutropenia and polyneuropathy (PNP) being the most common events. More than two treatment lines were given to 48.2% of patients. Conclusions: The use of ramucirumab in combination with FOLFIRI showed favourable PFS and OS in patients with prior treatments with platinum and/or taxane-based agents and allows further treatment lines after progression. In patients with taxane pretreatment or persistent high-grade PNP, the combination of FOLFIRI-R might be a promising combination.
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress, 1997
A total of 630 endoscopic thoracal sympathicotomies were performed for hyperhidrosis of the upper... more A total of 630 endoscopic thoracal sympathicotomies were performed for hyperhidrosis of the upper limbs, and complications and success rates were analyzed after a median follow-up period of 16 years (83% of patients). In all, 67.8% of patients were fully satisfied, 25.7% were partially satisfied and would again agree to the operation, and 93% the procedure terminated hyperhidrosis permanently. Compensatory and gustatory sweating was observed in 67% und 47% of cases, respectively, impairing the patients satisfaction. Overall success was significantly (p < 0.001) lower in the group with axillary hyperhidrosis.
The American Journal of Surgical Pathology, 2010
The human epidermal growth factor receptor-2 gene (HER-2) encodes for a membrane-bound tyrosine k... more The human epidermal growth factor receptor-2 gene (HER-2) encodes for a membrane-bound tyrosine kinase (Her-2), which is overexpressed in various human cancers. Her-2-targeted therapy has recently been shown to be beneficial for patients with advanced gastric cancer. Her-2 protein expression was investigated in 341 esophageal carcinomas [152 squamous cell carcinomas (SCC), 189 adenocarcinomas (AC)], 39 cases of Barrett mucosa, and 11 cases of squamous cell dysplasia. HER-2 gene amplification was assessed by colorimetric in-situ hybridization. Positive Her-2 status was found in 15.3% of ACs and 3.9% of SCCs. Positive Her-2-status was more common in dysplastic Barrett mucosas compared with nondysplastic ones (P=0.04). In 26% of the patients with ACs who had received neoadjuvant chemotherapy (n=39), the Her-2 status of pretherapeutic biopsies was different compared with subsequent surgical specimens. There was no statistically significant correlation between Her-2 status and patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; survival. Although Her-2 overexpression is rare in SCCs, it is found in 15.3% of ACs, where amplification of HER-2 gene and overexpression of Her-2 protein seem to be early events in carcinogenesis. The evaluation of Her-2 status in tumor biopsies and in particular in the context with possible alterations after neoadjuvant treatment can potentially lead to false Her-2-staging. Although Her-2-overexpression in esophageal cancer seems to have no influence on patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; survival, these subtypes of esophageal ACs have to be considered as targets for an anti-Her-2 therapy.
Diseases of the Colon & Rectum, 1999
Surgical Endoscopy, 2014
Background Both long-term proton pump inhibitor (PPI) use and surgical fundoplication have potent... more Background Both long-term proton pump inhibitor (PPI) use and surgical fundoplication have potential drawbacks as treatments for chronic gastroesophageal reflux disease (GERD). This multi-center, prospective study evaluated the clinical experiences of 69 patients who received an alternative treatment: endoscopic anterior fundoplication with a video-and ultrasound-guided transoral surgical stapler. Methods Patients with well-categorized GERD were enrolled at six international sites. Efficacy data was compared at baseline and at 6 months post-procedure. The primary endpoint was a C50 % improvement in GERD health-related quality of life (HRQL) score. Secondary endpoints were elimination or C50 % reduction in dose of PPI medication and reduction of total acid exposure on esophageal pH probe monitoring. A safety evaluation was performed at time 0 and weeks 1, 4, 12, and 6 months.
Journal für Gastroenterologische und Hepatologische Erkrankungen
European Journal of Plastic Surgery
The study was performed to evaluate abdominal complications related to jejunal segment resection ... more The study was performed to evaluate abdominal complications related to jejunal segment resection for reconstruction after radical oropharyngeal tumor resection. Perioperative complications of 104 patients (median age, 53.7 years; 23 female; 81 male) who underwent surgery for oropharyngeal malignancy after radiochemotherapy and the long-term morbidity of 35 patients after a median follow-up period of 21 months are analyzed. The perioperative mortality was 8.7% (9/104); none of the perioperative deaths was caused by an abdominal complication associated with the jejunal resection. In three cases, repeat laparotomy was performed within 30 days of jejunal autotransplantation: in two of them the reason was not directly associated with bowel resection and one patient had an abdominal wall dehiscence. In six cases there were minor abdominal complications which could be treated nonsurgically. There was no anastomotic leakage, bowel obstruction or postoperative bleeding. In the follow-up re-examination, no late onset abdominal complications were noted except small incisional hernias in six of the 35 patients; only one required a hernia repair. Despite a potentially increased operative risk in these patients, the complication rate after bowel resection for jejunal autotransplantation was low. This is a safe procedure in patients with oropharyngeal carcinoma.